Form I-312 - Nonresident Taxpayer Registration Affidavit Income Tax Withholding printable pdf download

Form I-312 - Nonresident Taxpayer Registration Affidavit Income Tax Withholding

STATE OF SOUTH CAROLINA

DEPARTMENT OF REVENUE

I-312

NONRESIDENT TAXPAYER

(Rev. 7/20/00)

REGISTRATION AFFIDAVIT

3323

INCOME TAX WITHHOLDING

The undersigned nonresident taxpayer on oath, being first duly sworn, hereby certifies as follows:

Owner, Partner(s) or Corporate Name of Nonresident Taxpayer:

Trade Name (Doing Business As):

Mailing Address:

Federal Identification Number:

Hiring or Contracting with:

Name:

Address:

Receiving Rentals or Royalties From:

Name:

Address:

I hereby certify that the above named nonresident taxpayer is currently registered with (check the appropriate box):

The South Carolina Secretary of State or

The South Carolina Department of Revenue

Date of Registration:

I understand that by this registration, the above named nonresident taxpayer has agreed to be subject to the

jurisdiction of the South Carolina Department of Revenue and the courts of South Carolina to determine its South

Carolina tax liability, including estimated taxes, together with any related interest and penalties.

I understand the South Carolina Department of Revenue may revoke the withholding exemption granted under Code

Sections 12-8-540 and 12-8-550 (Previously Code Section 12-9-310) at any time it determines that the above named

nonresident taxpayer is not cooperating with the Department in the determination of its correct South Carolina tax

liability.

The undersigned understands that any false statement contained herein could be punished by fine, imprisonment or

both.

Recognizing that I am subject to the criminal penalties under Code Section 12-54-44 (B) (6) (a) (i), I declare that I have

examined this affidavit and to the best of my knowledge and belief, it is true, correct and complete.

(Seal)

(Signature of Owner, Partner or Corporate Officer)

Date

If Corporate officer state title:

(Name - Please Print)

Form I-312 - Nonresident Taxpayer Registration Affidavit Income Tax Withholding